Coordinated Care for Hard-to-Reach Populations

Samantha Beasley, Health Care Policy Manager, L.A. Area Chamber

October 22, 2014

Coordinated Care for Hard-to-Reach Populations

When it comes to getting health care coverage for Los Angeles County’s residents, some of the very hardest-to-reach populations are those who are homeless or mentally ill. Although these are people who will most likely qualify for free Medi-Cal coverage, it’s estimated that up to 77 percent don’t understand or take advantage of the social services available to them. In continuation of this Chamber’s efforts to reach our county’s residually uninsured, including the homeless and mentally ill, today our Health Care Council will be discussing regional efforts to provide comprehensive mental health services and coordinated care with Supervisor Michael Antonovich and United Way.

As a community, we have some big, outstanding questions in terms of our commitment to the residually uninsured. The L.A. Area Chamber of Commerce already partners with United Way to fight homelessness in the County. Can we build on the existing efforts of organizations such as Home for Good to get the residually uninsured the comprehensive health care they need?

What is Home for Good?

Home for Good is a collective effort to end chronic and veteran homelessness in LA County by 2016. It is an initiative powered by the United Way of Greater Los Angeles, the L.A. Area Chamber of Commerce and driven by the combined forces of over one hundred cross-sector leaders and agencies.

These essential nonprofit, public and private partners work to streamline complex processes, advocate for more effective policies, and construct systems that ensure our homeless neighbors receive the services they need to get off the streets.

This work can be captured in three concrete objectives that lie at the heart of Home for Good:

  1. Understanding the exact needs of our homeless neighbors
  2. Securing the necessary resources to help them exit homelessness
  3. Optimizing the distribution of resources to those that need it.

What is CES?

To optimize the distribution of resources to those who need them, Home for Good has recently developed and deployed the Coordinated Entry System (CES). CES is a new platform that helps ensure every homeless person is known, assisted, and referred to the housing and support services (such as health care) that they need.

In recent years, Home for Good has continued to see spectacular outcomes from homeless programs and even innovative pilots that demonstrate new concepts in service delivery. However, these developments have largely had to fight against protocols and processes in the broader system that operate on older principles and as a result, it was not possible to scale them to meet the need. In computer speak, you can only upgrade your application so many times before you need a new operating system to go along with it.

The biggest element of the CES upgrade is this: housing providers are being able to see a real-time listing of all those who are the best fit for their resources. No more endless spreadsheets and waiting lists. And on the flip side, those seeking housing can enter their information through designated web portals and know that they are entering themselves into the pool of all available resources they are eligible for. No wrong door, no dead ends, and no endless string of intakes.

This has been achieved through the use of a common intake tool, adding matching tools and sharing functionalities to a secure real-time database, and having clear rules for prioritization of resources.

So what does this have to do with healthcare?

CES is an open-source platform, and Home for Good has been exploring how CES and its associated pieces (outreach teams, housing navigators, and coordinators stationed in all 8 regions of the County) can partner with health care providers to achieve greater success in securing housing and other needed services for patients.

Over the next six months, they will be engaging in tests of this system with specific regions to help distinguish the roles each party in the process should play (hospitals, health plans, clinics, homeless and housing providers, etc.). They are also exploring intersections with CSH's innovative 10th Decile Project as well as their exploration of future Health Homes funding for Los Angeles.

Home for Good is confident that such coordinated partnerships will result in more comprehensive health care and housing stability for patients, on top of more effective discharge practices and cost avoidance down the road. They believe CES can be an effective bridge that allows the homeless and health care providers to collaborate in unprecedented ways, and are excited to continue that conversation.


Total Votes: 1 Avg Vote: 1


Is this not a Los Angeles County healthcare issue? The taxpayers of the county put a lot into the county hospital systems to take care of those that do not have the access to the health insurance programs out there. I believe the county has to do a better job at their outreach to the homeless and uncovered individuals. I feel that there are so many programs out there, operated by the government, that it has made the whole issue of healthcare coverage and service very confusing. We in healthcare are highly concerned that with the over thrust of government involvement in so many programs that there will be people missed. Never will everyone understand the healthcare system and people will be lost in the confusion of programs.
Posted by: Michael Lodge @ 10:21:36 am

Leave a Comment

Comments submitted are subject to review by the Los Angeles Area Chamber of Commerce prior to posting. The Chamber reserves the right to monitor and withhold comments that include personal, offensive, potentially libelous or copyright protected language, materials or links. Only comments relevant to the topic will be posted. Comments posted must have a valid email address. View our full terms & conditions.